Iliopsoas Bursitis Symptoms, Causes & Treatment Options

This article will review the symptoms, causes, and management of iliopsoas bursitis. Symptoms include pain, swelling, and inflammation of groin and hip area as well as resultant limping in severe cases.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Iliopsoas Bursitis?

Summary

Iliopsoas bursitis is inflammation of the iliopsoas bursa, a large sac with fibrous connective tissue that is present along both hips in 98% of adults [1]. When a bursa is healthy, it is deflated. When it is inflamed, it begins to hold fluid, become enlarged, and cause pain and a loss of mobility [2]. Its function is to reduce the friction between the contracting muscles and bones of the hip.

Symptoms include pain, swelling, and inflammation in the groin and hip area as well as resultant limping in severe cases.

Treatment is mainly supportive depending on your level of pain, and will likely include activity modification for a period of time, pain medication, and possible steroid injections.

Recommended care

You should visit your primary care physician. Treatment for this condition usually involves avoiding activities that worsen the symptoms, over-the-counter pain medication, physical therapy, and steroid injections. Surgery is rarely needed.

Iliopsoas Bursitis Symptoms

Main symptoms

The following symptoms are all indicative of iliopsoas bursitis.

  • Pain, swelling, and inflammation: Pain occurs usually in concert with swelling and inflammation. There is often tenderness or pain experienced when touching the area just over the iliopsoas bursa. Interestingly, if a physician or moves the leg without flexing the muscles of the leg, pain may be more moderate or absent completely. It is voluntary movement of the leg involving muscle flexion that compresses an inflamed and swollen bursa causing pain. Pain is most pronounced in cases of “acute” or sudden iliopsoas bursitis as the swelling happens so rapidly the body does not have time to adjust and is extremely sensitive.
  • Limping: Iliopsoas bursitis is often only present on one side. If the pain is excessive it can cause differences in gait or a limping as an individual avoids triggering pain. This may involve avoidance of bending at the hip while moving up stairs, flexing the leg at the hip, or bringing the leg up to tie one’s shoe while sitting. Occasionally, iliopsoas bursitis can cause the gait of an affected leg to evoke a semi-circular motion away from the body to avoid bending the hip if it is particularly painful.

Iliopsoas Bursitis Causes

Inflammation of the bursa can occur when a flexed hip is rapidly extended (e.g. during a quick rise from a squat). Additionally, iliopsoas bursitis can also be triggered by tendonitis or occur at the same time as tendonitis. Iliopsoas bursitis is more common in young adults and women.

Arthritis

Rheumatoid arthritis and osteoarthritis can result in iliopsoas bursitis [3]. Rheumatoid arthritis affects the joint capsule space and can cause severe pain and deformity over time. It is also associated with rarer forms of arthritis like spondyloarthritis.

Acute trauma and overuse injuries

Bursitis-causing injuries are likely in those involved in sports that require flexing the hip multiple times. Runners, skiers, strength training and swimmers are commonly affected by iliopsoas bursitis. Over time, multiple small injuries sustained during sports activities cause inflammation and injury [3]. The body responds by diverting fluid to the bursa. The swelling and inflammation of the bursa can cause pain or discomfort on movement and with pressing upon the iliopsoas bursa.

Infection

While rare, infection of the joint can be serious and even life- or limb-threatening [4]. Bursitis involves infection just outside the joint. It is most frequently caused by an injury that tears the skin and opens the space around the bursa to the outside or from bacteria in the blood from a bladder or lung infection that spreads. It can also occur if bacteria from a nearby infection (i.e. a wound on the foot) infiltrates the blood and spreads.

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Treatment Options and Prevention for Iliopsoas Bursitis

Joint protection and ice

Generally, for similar conditions, it is recommended that the joint be protected from any further trauma. For iliopsoas bursitis, this may involve either a period of decreased activity or rest in which the sport or activity causing the bursitis is either stopped or significantly reduced in intensity. If the activity is simple or unavoidable like walking, it may be advisable to use a walking aid like a cane or a walker temporarily to relieve pressure while you’re healing. In some cases, when the joint cannot be protected by stopping the activity, it may be possible to be coached on how to alter behaviors and movements to place less strain on the affected joint. For mild cases, ice may also help.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs, or NSAIDs, are the mainstay in therapy for iliopsoas bursitis. They are used to control the primary cause of the condition (inflammation). Except in the setting of iliopsoas bursitis caused by rheumatoid arthritis, NSAIDs are often the most widely used and the most effective treatments. Two common types of studied NSAIDs are Celecoxib (Celebrex) and Naproxen (Aleve). Both were shown to be significantly better than a placebo treatment in independent trials. NSAIDs may increase the risk of bleeding, so people predisposed to bleed or to acquire injuries that may bleed should discuss taking NSAIDs with their physician first.

Intra-bursal injections of glucocorticoids

If the infection is more severe and affects some of the deeper bursae of the hip, it may be necessary to apply an injection of glucocorticoids into the affected bursa. Glucocorticoids are drugs in a class known as steroids. When injected locally, they can have a significant anti-inflammatory effect on the body and can often successfully decrease both swelling and pain to a significant degree. The care of a physician is required for this procedure, and he or she will initially numb or anesthetize the area before inserting the needle with the glucocorticoid solution into the hip. It is notable, however, a few hours after the injection (6-18 hours) a localized aggravation of symptoms can occur in some cases [1]. This usually subsides within a day or so as the maximal effect of the steroids is decreased.

When to Seek Further Consultation for Iliopsoas Bursitis

Iliopsoas bursitis is not a life- or limb-threatening condition. It can, however, limit mobility and has the potential to become infected.

If you experience limited movement that impacts your routine

If you experience a limitation in movement and find yourself limiting your daily activities due to your hip pain, it is advisable to see a medical professional for evaluation and pursuit of potential treatments. If treatment with over-the-counter anti-inflammatories (e.g. NSAIDs) fails, it is also advisable to return to your doctor to seek further advice on management.

If you experience other symptoms of illness

If you experience any signs of systemic illness such as fatigue, fever, chills, cough, or a general unwell feeling (malaise), please see your physician immediately. Any prolonged changes in sensation or loss of sensation along the affected leg should be evaluated.

If you experience a change in bowel habits or a loss of bowel control

Any change in the ability to either use or hold your bowels or your urine may be a sign of a more serious condition that needs emergency evaluation.

Questions Your Doctor May Ask to Determine Iliopsoas Bursitis

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Do either of these describe your hip pain?
  • How would you explain why your hip hurts?
  • How long has your hip pain been going on?
  • How severe is your hip pain?
  • What is your body mass?

If you've answered yes to one or more of these questions

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References

  1. Iliopsoas Bursitis. Physiopedia. Physiopedia Link
  2. Di sante L, Paoloni M, De benedittis S, Tognolo L, Santilli V. Groin pain and iliopsoas bursitis: always a cause-effect relationship?. J Back Musculoskelet Rehabil. 2014;27(1):103-6. PubMed Link
  3. Biundo, JJ. Bursitis. Merck Manual Professional Version. Revised Nov. 2018. Merck Manuals Professional Version Link
  4. Truong J, Ashurst JV. Septic Bursitis. [Updated 2019 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. NCBI Link